COMPREHENSIVE OUTPATIENT SERVICES, INC

Provider Demographics

• NPI: 1083742365
• Name: COMPREHENSIVE OUTPATIENT SERVICES, INC
• Entity type: Organization
• Organization Name: COMPREHENSIVE OUTPATIENT SERVICES, INC
• Other - Org Name: <UNAVAIL>
• Authorized Official - Title/Position: PRESIDENT
• Authorized Official - Prefix: DR
• Authorized Official - First Name: BRUCE
• Authorized Official - Middle Name: LESLIE
• Authorized Official - Last Name: MERMELSTEIN
• Authorized Official - Credentials: ED D
• Authorized Official - Phone: 617-527-4610
• Mailing Address - Street 1: 76 SUMMER ST
• Mailing Address - City: FITCHBURG
• Mailing Address - State: MA
• Mailing Address - Zip Code: 01420-5783
• Mailing Address - Country: US
• Mailing Address - Phone: 978-345-6729
• Mailing Address - Fax: 978-342-7503
• Practice Address - Street 1: 76 SUMMER ST
• Practice Address - City: FITCHBURG
• Practice Address - State: MA
• Practice Address - Zip Code: 01420-5783
• Practice Address - Country: US
• Practice Address - Phone: 978-345-6729
• Practice Address - Fax: 978-342-7503
• EIN: <UNAVAIL>
• Is Organization Subpart?: Yes
• Parent Organization LBN: COMPREHENSIVE OUTPATIENT SERVICES INC
• Parent Organization TIN: <UNAVAIL>
• Enumeration Date: 2007-03-01
• Last Update Date: 2013-08-16

Provider Licenses

State	License ID	Taxonomies
MA	4196	101Y00000X, 101YM0800X, 101YP2500X, 101YS0200X, 103T00000X, 103TA0400X, 103TC0700X, 103TC2200X, 103TF0000X, 103TP2701X, 1041C0700X, 106H00000X, 163WP0807X, 2084P0800X, 251S00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	251S00000X	Agencies	Community/Behavioral Health
No	101Y00000X	Behavioral Health & Social Service Providers	Counselor		Group - Multi-Specialty
No	101YM0800X	Behavioral Health & Social Service Providers	Counselor	Mental Health	Group - Multi-Specialty
No	101YP2500X	Behavioral Health & Social Service Providers	Counselor	Professional	Group - Multi-Specialty
No	101YS0200X	Behavioral Health & Social Service Providers	Counselor	School	Group - Multi-Specialty
No	103T00000X	Behavioral Health & Social Service Providers	Psychologist		Group - Multi-Specialty
No	103TA0400X	Behavioral Health & Social Service Providers	Psychologist	Addiction (Substance Use Disorder)	Group - Multi-Specialty
No	103TC0700X	Behavioral Health & Social Service Providers	Psychologist	Clinical	Group - Multi-Specialty
No	103TC2200X	Behavioral Health & Social Service Providers	Psychologist	Clinical Child & Adolescent	Group - Multi-Specialty
No	103TF0000X	Behavioral Health & Social Service Providers	Psychologist	Family	Group - Multi-Specialty
No	103TP2701X	Behavioral Health & Social Service Providers	Psychologist	Group Psychotherapy	Group - Multi-Specialty
No	1041C0700X	Behavioral Health & Social Service Providers	Social Worker	Clinical	Group - Multi-Specialty
No	106H00000X	Behavioral Health & Social Service Providers	Marriage & Family Therapist		Group - Multi-Specialty
No	163WP0807X	Nursing Service Providers	Registered Nurse	Psychiatric/Mental Health, Child & Adolescent	Group - Multi-Specialty
No	2084P0800X	Allopathic & Osteopathic Physicians	Psychiatry & Neurology	Psychiatry	Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
MA	701784	Other	TUFTS
MA	1000930	Other	BEACON
MA	1300491	Medicaid
MA	600022632	Other	MAGELLAN
MA	M18559	Other	BCBS
MA	M18560	Other	BCBS
MA	M18561	Other	BCBS
MA	M21821	Other	GROUP P TAN
MA	M18561	Other	BCBS
MA	600022632	Other	MAGELLAN
MA	1300491	Medicaid
MA	=========	Other	PHCS
MA	=========	Other	FALLON
MA	M18560	Other	BCBS